Percutaneous angioplasty of the right and left main coronary and the left subclavian arteries in a patient with multilevel atherosclerosis
Bibliographic record
Abstract
Multilevel atherosclerosis is an inflammatory disease that often occurs in high-risk patients in an ageing population [1,2].Percutaneous treatment is a challenge for interventional cardiologists but is becoming more frequently recommended in patients with diffuse atherosclerosis [3,4].A 65-year-old female patient with hypertension, obesity, dyslipidaemia, and stable angina, who was treated with primary percutaneous coronary intervention (PCI) of the left anterior descending artery (LAD) and the right coronary artery (RCA) 18 years ago, was admitted to the our department with stable angina class II/III according to the Canadian Cardiovascular Society classification and left subclavian artery (LSA) steal syndrome.Coronary angiography showed diffuse atherosclerosis with critical stenosis of the RCA, the left main (LM) artery, the LAD, and the left circumflex artery (LCx).The significance of the LM stenosis was confirmed by intravascular ultrasound (IVUS) which revealed a minimal lumen area of 4.6 mm 2 (Fig. 1).According to the Heart Team recommendations, the patient was referred for staged PCI of the RCA and the LM/LAD/LCx.Successful PCI of the RCA with Resolute Integrity™ (Medtronic, Minneapolis, MN, USA) drug eluting stent (DES) implantation was performed during the initial hospitalisation.One month later, the second stage of IVUS-guided revascularisation of the LM/LAD/LCx was performed, with the implantation of two Resolute DESs (3.0 × 18 mm and 3.5 × 18 mm).The "kissing balloon" angioplasty was done and the proximal optimisation technique was used to optimise the bifurcation result.IVUS measurements confirmed the correct stent placement (Fig. 2).The ultrasound revealed a critical lesion in the LSA and significant subclavian steal syndrome with retrograde flow in the left vertebral artery.The patient was admitted again in order to undergo angiography of the subclavian and cerebral circulation.It revealed multiple atherosclerotic plaques in the aortic arch with critical stenosis of the LSA ostium.Percutaneous angioplasty of the ostial LSA lesion, with pre-dilatation using a Sterling 5.0/20 mm balloon (Boston Scientific, Marlborough, MA, USA) and Omnilink 8.0/19 stent (Abbott, Abbott Park, IL, USA) implantation, was performed.We observed normal cephalic flow through the left vertebral artery (Fig. 3).Staged percutaneous interventional procedures in patients with multilevel atherosclerosis are becoming more common and safe.Ultrasound is a very useful tool to diagnose multi-level arterial disease in the aortic arch and the peripheral arteries.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.003 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.005 | 0.004 |
| Insufficient payload (model declined to judge) | 0.004 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".